CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 Page: 1
List order: No List
Payclass Filters:LEA
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 65 5424.000000 135600.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 102.000000 5100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 17.750000 1268.0600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 25 45.000000 3214.8000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 52.000000 3714.8800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 10 7.000000 97.1600 13.8800
Subtotal (Total Children Is Unduplicated) 72 5647.750000 148994.9000 26.3813
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Total 5647.750000 148994.9000 26.3813
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Number of Children (Unduplicated) With at Least One Service 72
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Center 04
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
324 5647.750000 148994.9000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 324 5647.750000 148994.9000 0.0000